Achilles Tendinosis: Causes, Symptoms, and Treatment

Written by Medicover Team and Medically Reviewed by Dr Shashivardhan , Orthopedics

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Achilles tendinosis is a condition that affects the Achilles tendon, the largest tendon in the body located at the back of the ankle. It results from chronic overuse and degeneration of the tendon fibers, leading to pain and stiffness in the affected area. The main causes of Achilles tendinosis include repetitive stress on the tendon, sudden increases in physical activity, improper footwear, and inadequate stretching before exercise.

These factors can strain the tendon, causing it to break down and become less flexible over time. Understanding the underlying causes of Achilles tendinosis is crucial in managing the condition effectively and preventing further injury.

What are the Types Of Achilles Tendinosis?

Achilles Tendinosis can be classified based on the location and extent of tendon degeneration. These types help in understanding the affected region and guiding appropriate treatment approaches.

Non-Insertional Achilles Tendinosis: Affects the middle portion of the tendon above the heel. It is the most common type and often seen in active individuals due to repetitive stress.
Insertional Achilles Tendinosis: Affects the lower portion of the tendon where it attaches to the heel bone. It may involve bone spurs and calcification in chronic cases.
Mid-portion Degenerative Tendinosis: Characterized by progressive degeneration and thickening of the tendon fibers in the central region, often leading to pain and stiffness.
Chronic Degenerative Tendinosis: Long-standing condition with significant tendon degeneration, reduced elasticity, and increased risk of partial tears.

What are the Symptoms of Achilles Tendinosis?

Symptoms of Achilles Tendinosis typically develop gradually due to repeated stress on the tendon. They often worsen with activity and may improve with rest in early stages.

Pain and stiffness in the Achilles tendon, especially in the morning or after activity, are common symptoms of Achilles tendinosis.
Swelling or thickening of the Achilles tendon may be observed in individuals with Achilles tendinosis.
Tenderness to touch along the Achilles tendon is a hallmark sign of Achilles tendinosis.
A gradual onset of pain that worsens with activity and improves with rest is typical in Achilles tendinosis.
Limited range of motion in the ankle joint can be experienced by individuals with Achilles tendinosis.

What are the Causes of Achilles Tendinosis?

Achilles Tendinosis develops due to repeated stress and micro-tears in the Achilles tendon over time. It is commonly linked to overuse, biomechanical issues, and inadequate recovery between physical activities.

Overuse or repetitive stress from activities like running or jumping can lead to Achilles tendinosis.
Poor footwear choices, such as shoes lacking proper support or cushioning, may contribute to the development of Achilles tendinosis.
Sudden increases in physical activity intensity or duration, without adequate conditioning, can lead to Achilles tendinosis.
Tight calf muscles or reduced ankle flexibility can place increased strain on the Achilles tendon, leading to tendinosis.
Individuals with biomechanical issues, such as flat feet or high arches, may be more prone to Achilles tendinosis due to altered foot mechanics.

When to See a Doctor?

You should see an orthopaedic doctor for Achilles Tendinosis if symptoms persist, worsen over time, or begin to interfere with normal walking and physical activity. Early evaluation helps prevent progression and tendon damage.

Pain or stiffness in the Achilles tendon lasting more than 1-2 weeks
Swelling or thickening of the tendon that does not improve with rest
Increasing pain during walking, running, or daily activities
Difficulty pushing off the foot or reduced ankle strength
Pain that returns every time you resume activity
Sudden sharp pain or suspicion of tendon injury

These could be signs of a serious complication like Achilles Tendon Rupture, which needs urgent care.

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How is the Diagnosis of Achilles Tendinosis Performed?

During the consultation, the healthcare provider will inquire about the onset of symptoms, any aggravating factors, and the patient's activity level. A physical exam may reveal tenderness, swelling, or thickening of the Achilles tendon.

Diagnosis of Achilles tendinosis typically involves a physical examination to assess for tenderness, swelling, and range of motion.
Imaging tests like ultrasound or MRI may be used to visualize the extent of tendon damage.
In some cases, a specialized diagnostic ultrasound called Doppler ultrasound may be used to evaluate blood flow in the tendon.
Medical history review is crucial to understand the onset of symptoms, previous injuries, and activities that may have contributed to the condition.

What Are the Treatment Options for Achilles Tendinosis?

Treatment for Achilles Tendinosis focuses on reducing tendon load, relieving pain, and promoting gradual healing through strengthening and rehabilitation strategies. Management is usually conservative and requires consistency for effective recovery.

Treatment Options for Achilles Tendinosis

Activity modification: Reducing or avoiding high-impact activities like running or jumping to prevent further tendon strain.
Rest and ice therapy: Helps reduce pain and inflammation in the affected area.
Physiotherapy: Includes eccentric strengthening exercises, stretching, and mobility training to improve tendon function.
Pain relief medications: NSAIDs may be used to manage pain in the short term.
Orthotic support: Heel lifts or custom shoe inserts to reduce stress on the Achilles tendon.
Calf muscle stretching: Improves flexibility and reduces tension on the tendon.
Gradual return to activity: Slowly resuming exercise under guidance to avoid re-injury.
Surgical intervention (rare cases): Considered only when severe symptoms do not improve with conservative treatment.

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What are the Risk Factors of Achilles Tendinosis?

Overuse or repetitive stress on the Achilles tendon from activities like running or jumping increases the risk of Achilles tendinosis.
Tight calf muscles and poor flexibility can contribute to increased strain on the Achilles tendon, leading to tendinosis.
Sudden increases in physical activity or training intensity without proper progression may overload the Achilles tendon, raising the risk of tendinosis.
Individuals with foot mechanics issues such as flat feet or high arches are more prone to developing Achilles tendinosis due to altered biomechanics.
Factors like age, obesity, and certain medical conditions like diabetes can weaken the Achilles tendon, making it more susceptible to tendinosis.

Additionally, age, obesity, certain medical conditions such as diabetes or high blood pressure, and smoking are also known to increase the risk of developing this condition. Taking steps to address these risk factors through proper training techniques, appropriate footwear, and lifestyle modifications can help reduce the likelihood of experiencing Achilles tendinosis.